What is Norepinephrine Injection?

A norepinephrine injection is a life-saving drug. It acts as a vasopressor, mainly used to boost blood pressure.

This is crucial for people with severe low blood pressure, such as those in septic shock, neurogenic shock, or cardiac arrest.

It is a synthetic form of norepinephrine (noradrenaline). This catecholamine acts as both a hormone and a neurotransmitter in the body.

It is given through an IV and narrows blood vessels while raising heart rate and cardiac output slightly. This makes more blood flow to important organs.

Overview

Description

Norepinephrine injection is a clear to light yellow fluid given through an IV. To reduce tissue damage from extravasation, it’s mixed with dextrose fluids.

Then, it’s given through a central venous catheter.

Uses of Norepinephrine Injection

Primary Uses

Treatment of abrupt hypotension in septic, anaphylactic, cardiogenic, or neurogenic shock

When fluid resuscitation fails to adequately treat hypotension.

Indications

Septic shock. Hypotension following a cardiac arrest

Acute hypotension during surgery.

Vasodilatory shock is unresponsive to volume replacement.

Neurogenic shock from spinal cord damage

Benefits

Immediate action as it quickly brings blood pressure back to normal

Increases the amount of blood that flows to the kidneys, heart, and brain

There is strong evidence that the first-line drug works well for treating sepsis. You can adjust the dose based on each patient’s needs.

Dopamine and epinephrine both cause more tachycardia than this.

Side Effects

How Does Norepinephrine Injection Work?

It also has weak activation of beta-1 adrenergic receptors. This raises heart rate and contraction force, which helps boost cardiac output.

It mainly affects the vascular smooth muscle. It raises systemic vascular resistance and arterial blood pressure.

Unlike epinephrine, it does not change heart rhythm or rate. It treats life-threatening low blood pressure caused by septic shock, myocardial infarction, or anesthesia-induced hypotension.

Norepinephrine stabilizes emergency and critical care patients by sustaining organ perfusion.

Dosage Guidelines

Start giving 8–12 mcg/min through an IV to an adult.

Set the dose between 2 and 30 mcg/min depending on how the patient reacts and your blood pressure goals.

Make changes every two to three minutes as needed while being constantly watched.

Directions for Use

Given through a constant IV infusion

For long-term administration, central venous access is recommended.

To get the right dose, use an intravenous pump.

Regularly check the blood pressure, ECG, urine flow, and peripheral circulation.

Do not mix with other drugs that are in the same IV line.

When Not to Use

Some of the contradictions are:

Uncorrected hypovolemia despite fluid administration. Peripheral vascular thrombosis.

Mesenteric ischemia. Documented hypersensitivity to norepinephrine or sulfites (in some formulations)

Drug Interactions

Safety Advice

Always make up for lost fluids before giving. Do not use in peripheral veins for long amounts of time.

Keep a look out for symptoms of poor circulation, such as cyanosis and chilly limbs.

Slowly lower the amount to avoid low blood pressure again

Be careful with older people, people with coronary heart disease, high blood pressure, or arrhythmias.

General Instructions

Stop slowly to avoid returning low blood pressure. If the drug leaks out, treat the area with phentolamine.

Only use a freshly prepared and properly diluted solution. Check the IV spot often for infiltration or phlebitis.

Dietary & Lifestyle Recommendations

Norepinephrine injection patients rarely have to observe any specific dietary restrictions. Cardiovascular health is important, especially for shock or severe hypotension patients.

Eat a heart-healthy diet to boost recovery and lower the risk of heart problems. Focus on fruits, vegetables, healthy grains, and lean proteins. 

Also, limit your intake of saturated fat and salt. If there are no heart or kidney failure issues, staying hydrated helps keep blood volume and circulation.

Alcohol and smoking may elevate blood pressure and damage arteries.

To stay stable and prevent low blood pressure episodes, you need to:

Patients should measure their blood pressure at home.  If you detect any unexpected symptoms, notify your doctor. This includes dizziness, feeling very tired, or heart palpitations.

Comparison with Other Treatments

Norepinephrine injection is a first-line treatment for acute hypotension and septic shock in critical care. It works well because it has strong vasoconstrictive effects.

In septic shock, norepinephrine is safer and more effective than dopamine, epinephrine, vasopressin, and phenylephrine.

Norepinephrine is more stable for blood flow and has fewer heart side effects than dopamine. Dopamine can cause arrhythmias when given in high doses.

Epinephrine can treat anaphylactic shock and cardiac arrest. But it can also lead to hyperglycemia and lactic acidosis.

Vasopressin, along with norepinephrine, narrows the blood vessels. It operates in a distinct manner and is often reserved for difficult instances.

Phenylephrine works well but has weak inotropic effects. It may lower cardiac output, so it’s not a good first-line treatment.

Norepinephrine is preferred because it works quickly, is strong, and safely restores blood flow in critically ill patients.

Precautions & Warnings

Use under great care in people with hyperthyroidism or hypertension.

Steer clear of extravasation; it can seriously harm or necrose tissue.

During administration, constant observation of blood pressure and heart activity is absolutely vital.

Not recommended for people with mesenteric or peripheral arterial thrombosis unless absolutely necessary.

It may produce reflex bradycardia; keep a constant eye on heart rate.

Patients sensitive to norepinephrine or any of its components should not follow this advice.

Use with Other Medications

Often co-administered with:

Crystalloids/colloids – to maintain intravascular volume.

Vasopressin – synergistic effect in septic shock.

Dobutamine – inotropic support in cardiogenic shock.

Storage

Store between 2 and 8 degrees Celsius (refrigerator).

Protect from light. Do not freeze.

Use a diluted solution after twenty-four hours.

Throw away if it is discolored or has particles.